Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

I was wondering if using a vacuum extractor during childbirth is
safe. I've read horror stories about it leading to brain
injuries in newborns. There is just so much misinformation &
information out there on the internet today. I did a google
search and found this
article on vacuum extraction birth that basically says it
increases the chance of a brain injury. Are some vacuum extractors
better than others? Are any safe? Do I have any choice in the
matter?

Well, of course attorneys trolling for business are
going to portray vacuum extraction in the worst possible light. On
the other hand, vacuum extraction is far from harmless. Here is an
excerpt from the assisted delivery chapter from the forthcoming new
edition of Obstetric Myths Versus Research Realities (in
press with University of Michigan Press):

Turning to the neonatal harms of instrumental vaginal
delivery, after adjustment for confounding factors, both forceps
delivery and vacuum extraction are associated with an intrinsic
risk of 1 more neonatal death per 10,000 compared with spontaneous
birth. This does not argue for cesarean surgery instead because
cesarean surgery imposes an intrinsic risk of 1 more neonatal death
per 1000,58 plus it imposes future reproductive risks.
Moving on to morbidity, 1 more baby per 1000 will experience
intracranial hemorrhage with vacuum or forceps compared with
spontaneous birth, and, according to a large Canadian study, 1 more
baby per 1000 will experience neonatal seizure, although a large
U.S. study reported a much smaller absolute difference. Compared
with spontaneous birth, 4-5 more babies per 1000 delivered with
forceps will experience facial nerve injury while excesses are
smaller with vacuum extraction: 0.5-1 per 1000. Excesses were
similar for brachial plexus injury (2 more babies per 1000). Vacuum
extraction results in much greater excesses of shoulder dystocia
(11 more babies per 1000) than forceps (1 more baby per 1000)
compared with spontaneous birth. Finally, a study that routinely
X-rayed all infants after vacuum extraction reported a 5% linear
(as opposed to depressed) skull fracture rate, although no infant
displayed neurologic symptoms or required treatment. Still, while
the authors viewed the lack of symptoms as reassuring, we do not.
Failure to display overt neurologic symptoms does not rule out
subtler adverse effects such as pain, for example, which might
interfere with breastfeeding and attachment during the crucial
early days of life. Indeed, all instrumental delivery-related nerve
compressions, swellings, and bruising hold this
potential.88

. . . On the maternal side, instrumental delivery causes
markedly more anal sphincter injuries compared with spontaneous
birth. In the United States and Canada, where median episiotomy is
the norm, 8-18 more women per 100 will experience anal sphincter
tears with vacuum extraction than with spontaneous delivery. In
primiparous women [first-time mothers], the excess may be as high
as 26 per 100. . . . Differences between instrumental
delivery and spontaneous birth would undoubtedly be greater were
episiotomy, especially median episiotomy, not used at spontaneous
birth as well.

Instrumental vaginal delivery is not, however, strongly
associated with pelvic floor dysfunction. By six months to a year
postpartum, few women with instrumental delivery are anally
incontinent, and of those who are, most are incontinent to flatus
only. This is understandable when one considers that anal
incontinence largely occurs secondary to sphincter
injury.67 Most women who have instrumental deliveries
will escape sphincter laceration, and even among those who do not,
most women with sphincter injury remain continent. This is not,
however, reason for complacency. Aging and further childbearing may
alter this picture. The sole longitudinal study we have found that
women with history of forceps delivery were more likely to report
fecal incontinence 12 years after the index birth compared with
only spontaneous vaginal births. Likewise, associations with stress
urinary incontinence are weak, and what little data we have do not
suggest an association with pelvic floor prolapse.

Women having instrumental vaginal delivery are also more
likely to be readmitted to hospital within 60 days of discharge
than women with spontaneous birth: 2.2% with forceps delivery and
1.8% with vacuum extraction versus 1.5% with spontaneous birth for
“pelvic injury/wounds,” “genitourinary
complications,” “obstetric surgical
complications,” and “major puerperal
infection.”

Finally, instrumental delivery may be associated with
increased risk of severe hemorrhage. Case-control studies have
reported increased risk of transfusion and peripartum hysterectomy,
although differences are not always significant.

Instrumental vaginal delivery has adverse psychological impact
as well. One study reported that both forceps and vacuum delivery
were associated with symptoms of psychological trauma.26
Another reported that vacuum extraction (no data on forceps) at
first delivery was an independent risk factor for fear of delivery
in second pregnancy.81 A third study that surveyed
women’s experience of instrumental vaginal delivery (type not
specified) reported that 70% of respondents said instrumental
delivery had upset them, increased their fear of childbirth, or
both.9 One-quarter of the group would prefer cesarean
surgery to a repeat instrumental vaginal delivery. A fourth found
that three years after difficult instrumental vaginal delivery, 16%
of survey respondents had no further children because they could
not go through childbirth again.10

There you have it. Certainly, there are situations where
the potential benefits of a timely vacuum extraction
outweigh the potential harms, but for most women and babies,
the safest, healthiest birth will be one without
episiotomy where mom pushes out the baby under her own
steam.

~ Henci

All Times America/New_York

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